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Boogers, M.J.; Chen, J.; Bommel, R.J. van; Borleffs, C.J.W.; Dibbets-Schneider, P.; Hiel, B. van der; ... ; Bax, J.J. (2011)

Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

Article / Letter to editor
The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of a parts per thousand yen15% in LVESV. Enrolled in the study were 90 patients (72% men, 67 +/- 10 years) with advanced heart failure. In 52 patients (58%), the LV lead was...Show moreThe aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of a parts per thousand yen15% in LVESV. Enrolled in the study were 90 patients (72% men, 67 +/- 10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p < 0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p < 0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables. Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.Show less
Site of latest mechanical activation LV lead SPECT Phase analysis CRT cardiac-resynchronization therapy heart-failure patients mechanical dyssynchrony predict response scar tissue site implantation association cardiology viability
All authors
Boogers, M.J.; Chen, J.; Bommel, R.J. van; Borleffs, C.J.W.; Dibbets-Schneider, P.; Hiel, B. van der; Younis, I. al; Schalij, M.J.; Wall, E.E. van der; Garcia, E.V.; Bax, J.J.
Date
2011-02-28
Journal
European Journal of Nuclear Medicine and Molecular Imaging
Volume
38
Issue
2
Pages
230 - 238
DOI
doi:10.1007/s00259-010-1621-z